H-1B holders can't start companies and can only stay up to six years. If they do decide to become permanent residents, they face long delays in visa processing, especially if they come from the most populous countries. The immigration department is currently processing visas for those Indians and Chinese who filed applications in 2001. Once these workers have filed for permanent residence, they can't change employers or even be promoted to a different job in the same company—or they have to restart the application process and move to the back of the line. Their spouses aren't allowed to work or obtain Social Security numbers—which are usually needed for things like driver's licenses and bank accounts. And these workers can't lay deep roots in American society because of the uncertainty about their future.
The H-1B visa is a bad deal for American workers, talented immigrants, and domestic economic development. If I understand Wadhwa correctly, uncapping the number of visas allocated only in the Rust Belt would do considerable damage to the mega-regional labor market. What would be more effective in terms of job creation would be expedited permanent residency for immigrants involved in the start-up economy. At the very least, the Rust Belt should be the area targeted for the kind of reform that the Programmers Guild suggests and Wadhwa supports.
I'm not sure if IT business titans such as Bill Gates would support these policy innovations. As the above quote from Wadhwa indicates, Microsoft most certainly benefits from the current captive labor market of H-1B visa immigrants. However, Gates and others would have to be very careful how they raise any objections or they could lose the appearance of being concerned about America's brain drain.